Silhouette of a man in nature. Text: Borderline Personality Disorder in Men
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Borderline Personality Disorder in Men: A Common Co-Occurring Disorder

Borderline personality disorder (BPD) is a serious mental illness that can go hand-in-hand with substance abuse. The disorder is characterized by pervasive mood instability, difficulty with interpersonal relationships, negative self-image, and harmful behavior. Historically, borderline personality disorder in men has been under-diagnosed, leading people to believe that it is a largely female disorder.

However, that misconception couldn’t be farther from the truth. Anyone can suffer from BPD, regardless of gender. Researchers now believe that it may affect men, women, and gender non-conforming individuals in equal numbers.

What Is Borderline Personality Disorder in men?

One reason borderline personality disorder in men (BPD) is overlooked is that men often present symptoms differently.

BPD is associated with high rates of self-harm and, in severe cases, suicidal behavior. The high risks for suicide and greater impairment are highest in the young adult years. For men with BPD, this self-harm often takes the form of substance abuse. Heavy drinking or drug use is a common response to unmanageable depression or anxiety. People with many mental health issues drink or use as a way to self-medicate, and borderline personality disorder is no exception.

Man holding head in hands. Text: Borderline personality disorder can result in depression or anxiety that last hours to days long.

Men’s negative emotions may also be perceived differently. Episodes of intense anger (which can happen to anyone with BPD) might be overlooked in men due to gender stereotyping. Unfortunately, volatile or violent outbursts are often accepted as “normal” male behavior, when they could actually be a symptom of BPD.

What Causes Male Borderline Personality Disorder?

The causes of Borderline Personality Disorder can be hard to accurately define. BPD does run in families, but it’s unknown whether this is completely due to genetics. It can also be affected by family history and past trauma, leading to the fear of abandonment that so many men with this disorder expereince.

Borderline personality disorder is characterized by:

  • Intense bouts of anger, depression or anxiety that last hours to days long
  • Episodes of impulsive aggression, self-injury or drug or alcohol abuse
  • Distorted thoughts and negative sense of self
  • Frequent and impulsive changes in life-altering decisions
  • Highly unstable patterns of social relationships
  • High sensitivity to rejection
  • Impulsive behaviors like excessive spending, risky sex and binge eating

Borderline Personality Disorder Vs. Bipolar Disorder

It is common to see borderline personality disorder occur with other psychiatric problems, particularly bipolar disorder (BD), depression, anxiety disorders, substance abuse and other personality disorders. This is true for many of the men we treat at Reflections.

While Borderline Personality Disorder and Bipolar Disorder may share some symptoms, they are very different in terms of long-term treatment. BPD is a personality disorder, while bipolar is a mood disorder. Though they can both cause mood swings, people with BPD experience shorter outbursts of anger and sadness as a result of long-term emotional dysfunction. People with bipolar deal with recurring bouts of alternating mania and depression. BPD is also less common than BD.

Symptoms of Borderline Personality Disorder in Men

Borderline personality disorder in men is often overlooked and brushed off with a recommendation for an anger management class. Men tend to externalize behaviors like aggression, violent patterns and antisocial traits, including heavier substance use than women.

Here are some ways BPD manifests in men:

  • Responding to criticism with aggression
  • Holding grudges
  • Displaying jealousy as a mask for fear of rejection
  • Using sex to alleviate feelings of rejection
  • Rejecting relationships and moving quickly from love to hate
  • Viewing others in absolutes (they are either entirely “good” or “bad”)
  • Using alcohol or drugs to relieve constant anxiety

Illustration of a faceless man standing alone. Text: The vast majority of men with borderline personality disorder go undiagnosed.

Sometimes these externalized behaviors are misdiagnosed as antisocial personality disorder, anger management problems or something else. Ironically, people with BPD complain of feeling misunderstood and in reality, they are being misunderstood and misdiagnosed.

Borderline Personality Disorder Relationships: What Does It Look Like If A Man You Know Has BPD?

He Struggles to Maintain Healthy Relationships

A series of intense but stormy relationships is often the first thing people notice about a man with BPD. People with BPD can fall in love quickly, and fall out of it just as fast.

Similarly, in a friendship or family relationship, a man with BPD may be quick to cut ties and slow to let go of grudges. When he has been offended, he might burst out without warning or stop all contact with loved ones, attempting to cut them out of his life.

He Has a Deep Fear of Abandonment

A man with BPD may harm people and bring excessive emotion and drama to relationships, but deep down he usually doesn’t want to hurt people. He just wants to be loved and is desperate for it. Men with BPD appear needy and manipulative, but they are desperately seeking to feel love they may never have felt before.

He Displays Hostile or Manipulative Behavior

It’s essential to remember that when symptomatic, a man with BPD is walking around in a living hell. His outer aggression is masking incredible inner pain, depression and anxiety.

This is never a reason to enable someone with BPD or allow them to compromise your personal safety, but it is a clear sign that they need treatment.

Dependent, dramatic and highly manipulative, BPD sufferers have learned to cope in these dysfunctional ways due to the overwhelming fear and emotional pain they endure.

He Abuses Alcohol or Drugs

The emotional instability coupled with impulsivity places individuals with BPD at risk of drug or alcohol abuse. It may or may not look like “textbook” addiction, and bouts of drug use might be spontaneous or short-lived. This does not mean that they are any less life-threatening. Individuals with BPD and a substance use disorder are at a very high risk for self-harm, and should recieve professional care for both disorders.

The Myth of BPD as a Female Disorder

Women are diagnosed with BPD at a ratio of 3-to-1 to men. However, in general, population studies, the occurrence rates are evenly distributed. While it is true that statistically more women than men are diagnosed with BPD, there are reasons for the statistics.

Men, in general, are more averse to seeking professional help for medical or mental problems. And when they do talk to a counselor or doctor, BPD is often misdiagnosed in men.

In fact, the vast majority of men with borderline personality disorder go undiagnosed.

Men are often undiagnosed or misdiagnosed because BPD manifests differently in men than women and is interpreted differently.

BPD and Substance Abuse: Common Co-Occurring Disorders

Only medical professionals are qualified to accurately diagnose mental health conditions, such as personality disorders. However, very often it is the partner or family member who brings to light the issues that the victim of the disorder cannot see himself.

If you notice that your male friend or loved one exhibits frequent irrational behavior, substance abuse and borderline personality disorder or another underlying mental health problem may be to blame.

The Cycle of Addiction: Binge/Intoxication, Withdrawal/Negative Effect, Preoccupation/Anticipation.

BPD Symptoms that Overlap with Drug Abuse

The relationship between BPD and addiction is as stormy as the individual’s personal relationships.

The alcoholism or substance can bring out and intsnsify antisocial behaviors like rage, anger and depression.

Yet, the man suffering from borderline personality feels a strong need to use drugs or alcohol to numb his numerous fears and to stop his mind from racing with constant free-floating anxiety.

Several symptoms of BDP are similar to symptoms of addiction, so it can be complicated to determine whether someone has a dual diagnosis. Both conditions display traits of:

  • Impulsivity and instability in job, relationships, finances and responsibilities
  • Apparent lack of concern for one’s own well-being
  • Mood swings and depression
  • Manipulative, deceitful actions to get what the person wants

Types of Treatment for BPD and Substance Abuse

Drug Abuse Treatment

Because the signs and symptoms of BPD and addiction have some overlap, these diseases can be difficult to distinguish and treat while at a traditional rehab center. Unless you find a co-occurring disorder rehab center, the facility will not have the resources to properly treat your loved one.

Borderline Personality Disorder Treatment

BPD is a serious psychiatric illness, and treating it is notoriously challenging, but there are various modalities available.

Medication may be part of the solution for some people. Behavioral modifications along with psychotherapy and group, peer and family support are key therapies as well.

Additionally, exercising and consuming foods or supplements high in choline and tryptophan can benefit neurotransmitters such as acetylcholine and serotonin, which help with emotion and mood regulation. Natural bright light helps, and meditation has been proven to increase dopamine in the brain.

Why Men’s Only Rehab May Be the Solution

Gender-specific rehabs get better results. Men and women have different reasons for using substances, heal differently, and have different reactions to treatments. By focusing on only men, rehab can be uplifting in shared experiences and bonding with peers — a proven necessary component of recovery — in a way that can’t always happen in a co-ed setting.

3 men talking and laughing together. Text: By focusing on only men, rehab can be uplifting in shared experiences and bonding with peers.

Can BPD Be Cured? Hope for Men with BPD and Addiction

There is no hard-and-fast cure for borderline personality disorder. People with BPD often need extensive mental health services, including hospitalization. Yet, with help, many BPD sufferers improve over time and lead productive lives.

The addiction counseling services and behavior therapies for drug abuse offered at Reflections Recovery Center have a long history of helping men recover from addiction. Additionally, our team has the know-how and experience to uncover underlying mental health illnesses while treating the drug abuse or alcohol problem.

Recovery can be intense, especially when facing a dual diagnosis, but we have seen many men heal from the enormous emotional burdens the disease of addiction placed on them and their loved ones.

If you suspect your loved one struggles with addiction and borderline personality disorder or another mental health issue, do not hesitate to get him into a program that addresses the addiction, has a working knowledge of dual diagnosis and treats co-occurring disorders.

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